Topical Treatments

  • Caleb JeonEmail author
  • Sahil Sekhon
  • Tina Bhutani
  • John Koo
Part of the Updates in Clinical Dermatology book series (UCD)


Psoriasis is a chronic inflammatory skin disease that affects 2–4% of the world’s population. Approximately 80% of psoriasis patients have limited, localized mild-to-moderate disease where topical therapies serve as the mainstay of treatment. Topical therapies can provide both high efficacy as well as safety in this population. Furthermore, in patients with moderate-to-severe disease, short-term topical treatments may provide symptomatic relief, minimize doses of photo- or systemic therapy, and be of benefit for resistant lesions as part of a combination regimen. This chapter provides an evidence-based concise overview of the topical treatments for psoriasis including corticosteroids, vitamin D derivatives, tazarotene, calcineurin inhibitors, anthralin, salicylic acid, coal tar, and lactic acid.


Psoriasis Therapy Topical treatments 


  1. 1.
    Pearce DJ, Stealey KH, Balkrishnan R, ABJ F, Feldman SR. Psoriasis treatment in the United States at the end of the 20th century. Int J Dermatol. 2006;45(4):370–4.CrossRefPubMedGoogle Scholar
  2. 2.
    Leung DY, Bloom JW. Update on glucocorticoid action and resistance. J Allergy Clin Immunol. 2003;111:3–22.CrossRefPubMedGoogle Scholar
  3. 3.
    Kragballe K. Topical corticosteroids: mechanisms of action. Acta Derm Venereol Suppl (Stockh). 1989;151:7–10.Google Scholar
  4. 4.
    van de Kerkhof PCM, Vissers WHPM. The topical treatment of psoriasis. Skin Pharmacol Appl Ski Physiol. 2003;16(2):69–83.CrossRefGoogle Scholar
  5. 5.
    Almawi WY, Saouda MS, Stevens AC, Lipman ML, Barth CM, Strom TB. Partial mediation of glucocorticoid antiproliferative effects by lipocortins. J Immunol. 1996;157(12):5231–9.PubMedGoogle Scholar
  6. 6.
    Cornell RC, Stoughton RB. Correlation of the vasoconstriction assay and clinical activity in psoriasis. Arch Dermatol. 1985;121(1):63–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Krueger GG, O’Reilly MA, Weidner M, Dromgoole SH, Killey FP. Comparative efficacy of once-daily flurandrenolide tape versus twice-daily diflorasone diacetate ointment in the treatment of psoriasis. J Am Acad Dermatol. 1998;38(2 Pt 1):186–90.CrossRefPubMedGoogle Scholar
  8. 8.
    Katz HI, Gross E, Buxman M, Prawer SE, Schwartzel EH, Gibson JR. A double-blind, vehicle-controlled paired comparison of halobetasol propionate cream on patients with plaque psoriasis. J Am Acad Dermatol. 1991;25(6 Pt 2):1175–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Blum G, Yawalkar S. A comparative, multicenter, double blind trial of 0.05% halobetasol propionate ointment and 0.1% betamethasone valerate ointment in the treatment of patients with chronic, localized plaque psoriasis. J Am Acad Dermatol. 1991;25(6 Pt 2):1153–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Goldberg B, Hartdegen R, Presbury D, Smith EH, Yawalkar S. A double-blind, multicenter comparison of 0.05% halobetasol propionate ointment and 0.05% clobetasol propionate ointment in patients with chronic, localized plaque psoriasis. J Am Acad Dermatol. 1991;25(6 Pt 2):1145–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Katz HI, Hien NT, Prawer SE, Mastbaum LI, Mooney JJ, Samson CR. Superpotent topical steroid treatment of psoriasis vulgaris--clinical efficacy and adrenal function. J Am Acad Dermatol. 1987;16(4):804–11.CrossRefPubMedGoogle Scholar
  12. 12.
    Bruce S, Epinette WW, Funicella T, Ison A, Jones EL, Loss RJ, et al. Comparative study of calcipotriene (MC 903) ointment and fluocinonide ointment in the treatment of psoriasis. J Am Acad Dermatol. 1994;31(5 Pt 1):755–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Molin L, Cutler TP, Helander I, Nyfors B, Downes N. Comparative efficacy of calcipotriol (MC903) cream and betamethasone 17-valerate cream in the treatment of chronic plaque psoriasis. A randomized, double-blind, parallel group multicentre study. Calcipotriol study group. Br J Dermatol. 1997;136(1):89–93.CrossRefPubMedGoogle Scholar
  14. 14.
    Tristani-Firouzi P, Krueger GG. Efficacy and safety of treatment modalities for psoriasis. Cutis. 1998;61(2 Suppl):11–21.PubMedGoogle Scholar
  15. 15.
    Diprolene® lotion (augmented betamethasone dipropionate 0.05%) product information. Kenilworth, NJ:Schering Corp; 1999.Google Scholar
  16. 16.
    Fowler JF Jr, Hebert AA. Sugarman J.DFD-01, a novel medium potency betamethasone dipropionate 0.05% emollient spray, demonstrates similar efficacy to augmented betamethasone dipropionate 0.05% lotion for the treatment of moderate plaque psoriasis. J Drugs Dermatol. 2016;15(2):154–62.PubMedGoogle Scholar
  17. 17.
    Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol. 2009;60(4):643–59.CrossRefPubMedGoogle Scholar
  18. 18.
    Rizova E, Corroller M. Topical calcitriol--studies on local tolerance and systemic safety. Br J Dermatol. 2001;144(Suppl 58):3–10.PubMedGoogle Scholar
  19. 19.
    Kragballe K. Treatment of psoriasis with calcipotriol and other vitamin D analogues. J Am Acad Dermatol. 1992;27(6 Pt 1):1001–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Barna M, Bos JD, Kapsenberg ML, Snijdewint FG. Effect of calcitriol on the production of T-cell-derived cytokines in psoriasis. Br J Dermatol. 1997;136(4):536–41.CrossRefPubMedGoogle Scholar
  21. 21.
    Patel B, Siskin S, Krazmien R, Lebwohl M. Compatibility of calcipotriene with other topical medications. J Am Acad Dermatol. 1998;38(6 Pt 1):1010–1.CrossRefPubMedGoogle Scholar
  22. 22.
    Hecker D, Worsley J, Yueh G, Lebwohl M. In vitro compatibility of tazarotene with other topical treatments of psoriasis. J Am Acad Dermatol. 2000;42(6):1008–11.CrossRefPubMedGoogle Scholar
  23. 23.
    Ashcroft DM, Po AL, Williams HC, Griffiths CE. Systematic review of comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis. BMJ. 2000;320(7240):963–7.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    van de Kerkhof PC, Franssen M, de La Brassine M, Kuipers M. Calcipotriol cream in the morning and ointment in the evening: a novel regimen to improve compliance. J Dermatolog Treat. 2001;12(2):75–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Feldman SR, Mills M, Brundage T, Eastman WJ. A multicenter, randomized, double-blind study of the efficacy and safety of calcipotriene foam, 0.005%, vs vehicle foam in the treatment of plaque-type psoriasis of the scalp. J Drugs Dermatol. 2013;12(3):300–6.PubMedGoogle Scholar
  26. 26.
    Mortensen L, et al. Treatment of psoriasis vulgaris with topical calcipotriol has no short-term effect on calcium or bone metabolism. A randomized, double-blind, placebo-controlled study. Acta Derm Venereol. 1993;73(4):300–4.PubMedGoogle Scholar
  27. 27.
    Traulsen J. Bioavailability of betamethasone dipropionate when combined with calcipotriol. Int J Dermatol. 2004;43(8):611–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Douglas WS, Poulin Y, Decroix J, Ortonne JP, Mrowietz U, Gulliver W, et al. A new calcipotriol/betamethasone formulation with rapid onset of action was superior to monotherapy with betamethasone dipropionate or calcipotriol in psoriasis vulgaris. Acta Derm Venereol. 2002;82(2):131–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Kaufmann R, Bibby AJ, Bissonnette R, Cambazard F, Chu AC, Decroix J, et al. A new calcipotriol/betamethasone dipropionate formulation (Daivobet) is an effective once-daily treatment for psoriasis vulgaris. Dermatology. 2002;205(4):389–93.CrossRefPubMedGoogle Scholar
  30. 30.
    Guenther L, Van de Kerkhof PCM, Snellman E, Kragballe K, Chu AC, Tegner E, et al. Efficacy and safety of a new combination of calcipotriol and betamethasone dipropionate (once or twice daily) compared to calcipotriol (twice daily) in the treatment of psoriasis vulgaris: a randomized, double-blind, vehicle-controlled clinical trial. Br J Dermatol. 2002;147(2):316–23.CrossRefPubMedGoogle Scholar
  31. 31.
    Lebwohl M, Tyring S, Bukhalo M, Alonso-Llamazares J, Olesen M, Lowson D, et al. Fixed combination aerosol foam Calcipotriene 0.005% (Cal) plus betamethasone Dipropionate 0.064% (BD) is more efficacious than Cal or BD aerosol foam alone for psoriasis vulgaris: a randomized, double-blind, multicenter, three-arm, phase 2 study. J Clin Aesthet Dermatol. 2016;9(2):34–41.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Paul C, Stein Gold L, Cambazard F, Kalb RE, Lowson D, Bang B, et al. Calcipotriol plus betamethasone dipropionate aerosol foam provides superior efficacy vs. gel in patients with psoriasis vulgaris: randomized, controlled. J Eur Acad Dermatol Venereol. 2017;31(1):119–26.CrossRefPubMedGoogle Scholar
  33. 33.
    Koo J, Tyring S, Werschler WP, Bruce S, Olesen M, Villumsen J, et al. Superior efficacy of calcipotriene and betamethasone dipropionate aerosol foam versus ointment in patients with psoriasis vulgaris--a randomized phase II study. J Dermatolog Treat. 2016;27(2):120–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Krueger GG, Drake LA, Elias PM, Lowe NJ, Guzzo C, Weinstein GD, et al. The safety and efficacy of tazarotene gel, a topical acetylenic retinoid, in the treatment of psoriasis. Arch Dermatol. 1998;134(1):57–60.CrossRefPubMedGoogle Scholar
  35. 35.
    Duvic M, Asano AT, Hager C, Mays S. The pathogenesis of psoriasis and the mechanism of action of tazarotene. J Am Acad Dermatol. 1998;39(4 Pt 2):S129–33.CrossRefPubMedGoogle Scholar
  36. 36.
    Lebwohl M, Ast E, Callen JP, Cullen SI, Hong SR, Kulp-Shorten CL, et al. Once-daily tazarotene gel versus twice-daily fluocinonide cream in the treatment of plaque psoriasis. J Am Acad Dermatol. 1998;38(5 Pt 1):705–11.CrossRefPubMedGoogle Scholar
  37. 37.
    Koo JY, Martin D. Investigator-masked comparison of tazarotene gel q.D. Plus mometasone furoate cream q.D. vs. mometasone furoate cream b.I.D. In the treatment of plaque psoriasis. Int J Dermatol. 2001;40(3):210–2.CrossRefPubMedGoogle Scholar
  38. 38.
    Lebwohl M, Poulin Y. Tazarotene in combination with topical corticosteroids. J Am Acad Dermatol. 1998;39(4 Pt 2):S139–43.CrossRefPubMedGoogle Scholar
  39. 39.
    Lesnik RH, Mezick JA, Capetola R, Kligman LH. Topical all-trans-retinoic acid prevents corticosteroid-induced skin atrophy without abrogating the anti-inflammatory effect. J Am Acad Dermatol. 1989;21(2 Pt 1):186–90.CrossRefPubMedGoogle Scholar
  40. 40.
    Smith EL, Walworth NC, Holick MF. Effect of 1 alpha,25-dihydroxyvitamin D3 on the morphologic and biochemical differentiation of cultured human epidermal keratinocytes grown in serum-free conditions. J Invest Dermatol. 1986;86(6):709–14.CrossRefPubMedGoogle Scholar
  41. 41.
    Lebwohl M, Lombardi K, Tan MH. Duration of improvement in psoriasis after treatment with tazarotene 0.1% gel plus clobetasol propionate 0.05% ointment: comparison of maintenance treatments. Int J Dermatol. 2001;40(1):64–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Bowman PH, Maloney JE, Koo JYM. Combination of calcipotriene (Dovonex) ointment and tazarotene (Tazorac) gel versus clobetasol ointment in the treatment of plaque psoriasis: a pilot study. J Am Acad Dermatol. 2002;46(6):907–13.CrossRefPubMedGoogle Scholar
  43. 43.
    Lowe NJ. Optimizing therapy: tazarotene in combination with phototherapy. Br J Dermatol. 1999;140(Suppl 54):8–11.CrossRefPubMedGoogle Scholar
  44. 44.
    Koo JY, Lowe NJ, Lew-Kaya DA, Vasilopoulos AI, Lue JC, Sefton J, et al. Tazarotene plus UVB phototherapy in the treatment of psoriasis. J Am Acad Dermatol. 2000;43(5 Pt 1):821–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Behrens S, Grundmann-Kollmann M, Schiener R, Peter RU, Kerscher M. Combination phototherapy of psoriasis with narrow-band UVB irradiation and topical tazarotene gel. J Am Acad Dermatol. 2000;42(3):493–5.CrossRefPubMedGoogle Scholar
  46. 46.
    Veraldi S, Caputo R, Pacifico A, Peris K, Soda R, Chimenti S. Short contact therapy with tazarotene in psoriasis vulgaris. Dermatology. 2006;212(3):235–7.CrossRefPubMedGoogle Scholar
  47. 47.
    Tazorac® gel product information. Irvine: Allergan Plc; 1997.Google Scholar
  48. 48.
    Freeman AK, Linowski GJ, Brady C, Lind L, Vanveldhuisen P, Singer G, et al. Tacrolimus ointment for the treatment of psoriasis on the face and intertriginous areas. J Am Acad Dermatol. 2003;48(4):564–8.CrossRefPubMedGoogle Scholar
  49. 49.
    Wilsmann-Theis D, Hagemann T, Dederer H, Wenzel J, Bieber T, Novak N. Successful treatment of acrodermatitis continua suppurativa with topical tacrolimus 0.1% ointment. Br J Dermatol. 2004;150(6):1194–7.CrossRefPubMedGoogle Scholar
  50. 50.
    Mrowietz U, Wustlich S, Hoexter G, Graeber M, Brautigam M, Luger T. An experimental ointment formulation of pimecrolimus is effective in psoriasis without occlusion. Acta Derm Venereol. 2003;83(5):351–3.CrossRefPubMedGoogle Scholar
  51. 51.
    Yamamoto T, Nishioka K. Topical tacrolimus: an effective therapy for facial psoriasis. Eur J Dermatol. 2003;13(5):471–3.PubMedGoogle Scholar
  52. 52.
    Wiederrecht G, Lam E, Hung S, Martin M, Sigal N. The mechanism of action of FK-506 and cyclosporin a. Ann N Y Acad Sci. 1993;696:9–19.CrossRefPubMedGoogle Scholar
  53. 53.
    Klintmalm GB. FK 506: an update. Clin Transpl. 1994;8(2 Pt 2):207–10.Google Scholar
  54. 54.
    Lebwohl M, Freeman AK, Chapman MS, Feldman SR, Hartle JE, Henning A. Tacrolimus ointment is effective for facial and intertriginous psoriasis. J Am Acad Dermatol. 2004;51(5):723–30.CrossRefPubMedGoogle Scholar
  55. 55.
    Carroll CL, Clarke J, Camacho F, Balkrishnan R, Feldman SR. Topical tacrolimus ointment combined with 6% salicylic acid gel for plaque psoriasis treatment. Arch Dermatol. 2005;141(1):43–6.CrossRefPubMedGoogle Scholar
  56. 56.
    Gribetz C, Ling M, Lebwohl M, Pariser D, Draelos Z, Gottlieb AB, et al. Pimecrolimus cream 1% in the treatment of intertriginous psoriasis: a double-blind, randomized study. J Am Acad Dermatol. 2004;51(5):731–8.CrossRefPubMedGoogle Scholar
  57. 57.
    Kreuter A, Sommer A, Hyun J, Brautigam M, Brockmeyer NH, Altmeyer P, et al. 1% pimecrolimus, 0.005% calcipotriol, and 0.1% betamethasone in the treatment of intertriginous psoriasis: a double-blind, randomized controlled study. Arch Dermatol. 2006;142(9):1138–43.PubMedGoogle Scholar
  58. 58.
    Center for Drug Evaluation and Research. Postmarket Drug Safety Information for Patients and Providers—Public Health Advisory for Elidel and Protopic (3/10/2005). U Public Health Advisory for Elidel and Protopic. Center for Drug Evaluation and Research, 10 Mar. 2015. Web. 18 May 2017. Scholar
  59. 59.
    Siegfried EC, Jaworski JC, Hebert AA. Topical calcineurin inhibitors and lymphoma risk: evidence update with implications for daily practice. Am J Clin Dermatol. 2013;14(3):163–78.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Tennis P, Gelfand JM, Rothman KJ. Evaluation of cancer risk related to atopic dermatitis and use of topical calcineurin inhibitors. Br J Dermatol. 2011;165(3):465–73.CrossRefPubMedGoogle Scholar
  61. 61.
    Schmidt KN, Podda M, Packer L, Baeuerle PA. Anti-psoriatic drug anthralin activates transcription factor NF-kappa B in murine keratinocytes. J Immunol. 1996;156(11):4514–9.PubMedGoogle Scholar
  62. 62.
    Morhenn VB, Orenberg EK, Kaplan J, Pfendt E, Terrell C, Engleman EG. Inhibition of a Langerhans cell-mediated immune response by treatment modalities useful in psoriasis. J Invest Dermatol. 1983;81(1):23–7.CrossRefPubMedGoogle Scholar
  63. 63.
    Klem EB. Effects of antipsoriasis drugs and metabolic inhibitors on the growth of epidermal cells in culture. J Invest Dermatol. 1978;70(1):27–32.CrossRefPubMedGoogle Scholar
  64. 64.
    Bonnekoh B, Bockelmann R, Ambach A, Gollnick H. Dithranol and dimethylfumarate suppress the interferon-gamma-induced up-regulation of cytokeratin 17 as a putative psoriasis autoantigen in vitro. Skin Pharmacol Appl Ski Physiol. 2001;14(4):217–25.CrossRefGoogle Scholar
  65. 65.
    Schaefer H, Farber EM, Goldberg L, Schalla W. Limited application period for dithranol in psoriasis. Preliminary report on penetration and clinical efficacy. Br J Dermatol. 1980;102(5):571–3.CrossRefPubMedGoogle Scholar
  66. 66.
    Goransson A. Comparison of dithranol and butantrone in short contact therapy of psoriasis. Acta Derm Venereol. 1987;67(2):149–53.PubMedGoogle Scholar
  67. 67.
    Statham BN, Ryatt KS, Rowell NR. Short-contact dithranol therapy—a comparison with the Ingram regime. Br J Dermatol. 1984;110(6):703–8.CrossRefPubMedGoogle Scholar
  68. 68.
    Lebwohl M. The role of salicylic acid in the treatment of psoriasis. Int J Dermatol. 1999;38(1):16–24.CrossRefPubMedGoogle Scholar
  69. 69.
    Koo J, Cuffie CA, Tanner DJ, Bressinck R, Cornell RC, DeVillez RL, et al. Mometasone furoate 0.1%-salicylic acid 5% ointment versus mometasone furoate 0.1% ointment in the treatment of moderate-to-severe psoriasis: a multicenter study. Clin Ther. 1998;20(2):283–91.CrossRefPubMedGoogle Scholar
  70. 70.
    Koo JY, Lebwohl MG, Lee CS, editors. Mild-to-Moderate psoriasis. New York: CRC Press; 2006.Google Scholar
  71. 71.
    Arnold WP. Tar. Clin Dermatol. 1997;15(5):739–44.CrossRefPubMedGoogle Scholar
  72. 72.
    Kim TH, Choi EH, Kang YC, Lee SH, Ahn SK. The effects of topical alpha-hydroxy acids on the normal skin barrier of hairless mice. Br J Dermatol. 2001;144(2):267–73.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Caleb Jeon
    • 1
    Email author
  • Sahil Sekhon
    • 1
  • Tina Bhutani
    • 1
  • John Koo
    • 2
  1. 1.Department of Dermatology, UCSF Psoriasis CenterUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of Dermatology, Psoriasis and Skin Treatment CenterUniversity of California San FranciscoSan FranciscoUSA

Personalised recommendations